IGNAZ PHILIPP SEMMELWEIS AND HIS TIMES

All theS?n ^ranz ^e last Holy Roman Emperor and the First Emperor of Austria. Which ,lntern^ problems were, however, overshadowed by the wars with France, Austria anc* ^aste<^ witb interruptions until 1814. These brought to Vie^a a series of disasters: Austria lost her possessions in Italy and the Rhineland, Univer ?pS tw*ce occupied by French armies and in 1806 Napoleon himself became he res: a ^-niperor. The prevailing instability made Franz II extremely conservative; resiSta change, popular initiative or indeed any movement in political affairs; his Josef jj? V3 change was such that he would not even alter the reforms made by Pfedece' a u?b he wholeheartedly disagreed with all reforms introduced by his ai* iftibecil^' ^ranz died in 1835 he was succeeded by his son Ferdinand almost ^rnin/t Un.stable and rather confused atmosphere a very powerful Civil Service and developed. Its head was the very able statesman Prince Clemens 111 a ^vider ettern*cb> who had the complete confidence of the Emperor and the court thp * ^enseThe many rules and regulations were exactly recorded and codified saying was: ^Ven the Tt ? "Quod non est in actis, non est in mundo". ^ei*ate ariri nulversity came under control of the Ministry and this affected the academic A profe ^e professors directly. 115 ?Wn d SS?r re?ius ordinarius once confirmed by the Emperor was all-powerful in yVersity^artment an<^ could not be removed unless he was offered a chair at another Picture. ^ ^is rigid imperial system the social life of Vienna offered a very different j^ethoVeri ere_. Wer.e ^ving or had recently lived Mozart, Haydn, Schubert and ,aUemfeld an?i a cVrc^e artists that included the painter Moritz Schwind, the poet J the v" r ? ^r^lparzer, the singer Vogl and many outstanding musicians, among se?iitie Was?HlrilSt ^reutzer to whom Beethoven dedicated the Kreutzer Sonata. If the ^ that this .0Ur.and gloomy, the population was gay and cheerful. Indeed, one can \y*trast to th'011-'0 m*xture persisted in Vienna until the end of the Empire. It was in

First T6 C^osen Ignaz Philipp Semmelweiss as the subject tonight for two reasons, to sV bave found that the name of Semmelweis is not very well known and I hope So ?,W,t^lat ^ is a name worthy to be remembered, and secondly he belonged to the I th u ^ec?nd Viennese School which once was famous all over Europe, and Let* ^?U m*?bt be interested to glimpse at those times.
Avere Us ^?. back to the end of the eighteenth century when considerable changes *n t'le bfe ?f the Austrian people, especially under the Emperor Josef II serfdo ' introcluced compulsory education from six to thirteen, abolished Privil?m and restricted the power of the Church, abrogating many clerical ^as r6^eS anc^ closing certain monasteries particularly those of the Jesuits. Serfdom by hisS 0rec^ by bis brother Leopold who reigned only two years and was succeeded All theS?n ^ranz ^e last Holy Roman Emperor and the First Emperor of Austria.
Which ,lntern^ problems were, however, overshadowed by the wars with France, Austria anc* ^aste<^ witb interruptions until 1814. These brought to Vie^a a series of disasters: Austria lost her possessions in Italy and the Rhineland, Univer ?pS tw*ce occupied by French armies and in 1806 Napoleon himself became he res: a ^-niperor. The prevailing instability made Franz II extremely conservative; resiSta change, popular initiative or indeed any movement in political affairs; his Josef jj? V3 change was such that he would not even alter the reforms made by Pfedece' a u?b he wholeheartedly disagreed with all reforms introduced by his ai* iftibecil^' ^ranz died in 1835 he was succeeded by his son Ferdinand almost ^rnin/t Un.stable and rather confused atmosphere a very powerful Civil Service and developed. Its head was the very able statesman Prince Clemens 111 a ^vider ettern*cb> who had the complete confidence of the Emperor and the court thp * ^ense-The many rules and regulations were exactly recorded and codified saying was: ^Ven the Tt ?
"Quod non est in actis, non est in mundo". The hospital which was the scene of the work and suffering of Semmelweiss was the Lying-in Division of the General Hospital of Vienna. It had been founded by we Empress Maria Theresia in gratitude to Van Swieten, her Dutch doctor and founder0 the greatness of the Viennese Medical School. The lying-in Division was found neces' sary because of the immense number of illegitimate children. This in turn was caused W a ridiculous law that forbad marriage to illiterates. Nor did this affect only the p00^ classes for even among the well to do, the number of illiterates was considerable. Tfl arrangements for admission to the Lying-in Division shed a sombre light on the sta of society The early figures of the Viennese School are an impressive line. After Van Swietej and Auenbrugger, who in the eighteenth century introduced percussion as a means0 diagnosis and prognosis came the pathologist Johannes Wagner, a Bohemian by birt he was one of the first who drew his conclusions from the changes in the affected orga and not from the symptoms alone. His personality drew men like Rokitansky, K0^ schka, Schuh ahd Skoda to Vienna. He died at 33 years of T.B. He was soon succeed by Rokitansky of Koeniggraetz in Bohemia. s Rokitansky started medical study in Prague in 1822, where the young Purkinje ^ one of his teachers, but he went to Vienna in 1824 and graduated there in 1829became an unpaid assistant to Wagner whom he succeeded, first as professor ordinarius, and in 1844 as ordinarius. Rokitansky is well remembered as the n\ widely experienced of all morbid anatomists; his series of post-mortems in 1 f begins with the number, 4,781 when he retired in 1875 (3Ist August) the serial num ^ is 64,571. In addition to these he made 25,000 forensic medical post-mortems-^ needed a great working capacity to sort out and adequately to present this enorfl1 material.
. ed Rokitansky's teaching then was that the great variety of diseases could be expl^ ^ by a great variety of the mixture of the blood (Humoral pathology). These views . quickly set aside when Virchow's Cellular-pathology (Omnis cellula, e cellula) be*j 0f known. Rokitansky had to work in two small rooms which could neither be heated (?) ventilated. There wasn't even enough light and to see properly it was necessa^ climb on to a chair placed on a table near the window. Not until 1862 that a ?, building was completed and over its door was fixed a quotation from Morga?0f Indagandis sedibus et causis morborum" ("For investigating of the seats and cans diseases").
Rokitansky never practised medicine himself, but he made himself available u in 1831 and again in 1832 a severe epidemic of cholera of which more than 5,000 p died in Vienna. In politics he was a liberal, in those days considered outrageous* ^ nevertheless he was created a Counsellor (Hofrat,) a baron and a member 0 ^ ( Herrenhaus (House of Lords). He died three years after his retirement on the July, 1878. _ , ^ The second Viennese School was completed by two great personalities, Skod ' p a little later, Hebra. Skoda was born in 1805 in Pilsen, again in Bohemia, the so $ ^ locksmith. He began to study medicine at Vienna University in 1825, where, ^ ^ friend Rokitansky, he had to support himself by coaching younger students, yhis degree in 1831 and became an unpaid assistant at the General Hospital in ^ In 1833 he became a paid assistant and so remained until 1839.
I^4? Head of the Department for Chest Diseases. , ^1 Medicine in general was then much under the influence of the philosophy of * ^ and might have so remained but for Skoda and those around him. We Hahnemann s homoeopathic doctrine: (1755-1842) Similia similibus curantur, a very fashionable in those days. Skoda's new findings developing the work 0 ^ bragger and were publicized by Franz Schuh. They were treated by his contemp yj with derision. It was a gibe of a professor von Hildebrand "I am fond of mu I have never heard a pneumonia play the fiddle". When Skoda retired in 1871 (( now it is up to the microscope and chemistry". Skoda's aim was to concentrate on the Physical methods of examination in diagnosis, a prognosis.
Ferdinand Hebra was an assistant of Skoda. He showed great interest in the diseases the skin. At that time all sub-departments or, as we now call them, specialities, came Under the supervision of the professor of general medicine. Skoda offered Hebra the Opportunity to take over the care and supervision of the skin case of his department thus Hebra became one of the founders of Dermatology. Prominent among para's pupils were Kaposi and Philip Josef Pick. Hebra linked dermatology to athology, influenced by Rokitansky and his first paper was on scabies. Among other Personalities of the Second Vienna School we may recall the anatomist Hyrtl, the Physiologist Bruegge, the physician Oppolzer, the surgeons Schuh and Dummreicher, 0 lowed later by the eye specialist Arlt and the greatest of all, Billroth.
Contrasted with these pioneers was Johann Klein, professor of obstetrics, he was a arrow minded official, obedient to his superiors but impatient with his subordinates, ^intelligent but very powerful, because he was not only regius professor and therefore inVr10Vable' kut a*so director of the General Hospital with its entire administration his hands. No changes were possible without his consent, every detail had to come ^tore him and was decided by him. Not only had he the final say in dealing with spital problems as such, but he also could transfer, admit or dismiss both lay and frQ Ica^ staff. Thus, for example, he transferred Skoda before he became professor, ?rri the General to a Mental Hospital in one of the suburbs because he disagreed onl .Coda's use ?f the stethoscope. Only when Skoda's views were recognized not Y ln Vienna but also further afield was Klein forced to recall Skoda. We shall meet a?a.n the ill-famed Klein. in ?eSe Were the men whom Semmelweis found when he came as a student to Vienna Wh Was b?rn in Budapest on the ist of July, 1818, the son of a shopkeeper.
fr: Gj,^e carne to Vienna he was looked on by the citizens as an alien from an unjj uly land for the awakening of nationalism had begun to cause tension with him ^~Ians who sought independence. Semmelweis, a rather poor student, found lawl * anc* lonely in a strange and unfriendly world. For a few months he studied and' changed to medicine. Rokitansky accidentally became aware of the poor b yn^ernourished looking young man and invited him to stay at his house. After a ret^ several months in Budapest, owing to the death of his mother, Semmelweis ^^ed to Vienna and, after qualifying, became assistant at the obstetrical clinic.
i^ej-6 ?hstetric clinic was divided into two parts, one was used for the training of Usedf Students and was under the immediate direction of Klein, while the other was ?nce h*" t^le *nstruction of midwives and was in charge of Bartsch. Semmelweis was at x0 locked by the enormous proportion of deaths in Klein's clinic, amounting to oCcjjrr-Cent-at least, sometimes rising to 20 per cent., while the number of deaths 4 pernn^ on the second clinic was much smaller, fluctuated between 3 per cent and ePide C-ent* authorities, who considered puerperal fever as a peculiar form of disease, blamed all sorts of atmospheric, telluric, cosmic, and miasmatic sP?nsihieS ^?r mortality in Klein's clinic. Again they made overcrowding re-beCaug e and it was even said that the sense of modesty was too frequently violated \Vere ^ male students came to examine the women. In the end foreign students While and ** was maintained that they were rough with the patients before and foreign Were in labour. This latter accusation went so far that the number of ^eaths rtudents was restricted and when there ensued no reduction in the number of This ?re*?n students were excluded from Klein's clinic.
to avoidStv,te a^a*rs became of course known among the people and the women tried ?ften a fi k ^rst ?hnic. The two clinics admitted on alternate days and there was very ^eis ty-f 1}(0t t0 he admitted to the "Death House" as it came to be named. Semmel-^eepin eS: 'One could see heart-rending scenes when patients on their knees asked to he discharged again after they found themselves by mistake in the first clinic while they had expected to be or had booked for the second. Women in childbed with an uncountable pulse rate, enormous meteorism, dry tongue, gravely ill with puerperal fever declared only a few hours before their death that they were quite all right, to avoid treatment, which they knew was but the fore-runner of death". Semmelweis was desperate and could find no explanation for the enormous proportion of deaths in the first clinic while that in the second clinic remained around 3 to 4 per cent.
The findings of the Royal Commission, which had blamed the foreigners, bad ventilation, dirty linen etc., in 1846 were to him not a sufficient explanation. He noticed, how" ever, that all women who had been in labour with a slow first stage were taken $ during the 24-36 hours after delivery and died very quickly and that the children also died soon afterwards. Yet a woman who was delivered in the street had a much lower morbidity?and mortality rate. In complete helplessness Semmelweis abolished the posterior position in labour used in the first clinic and introduced the lateral position just because it was practised in the second. Still the mortality rates remained the same. Depressed and exhausted, he went in the early spring of 1847 to Venice to forget the horrors at the clinic. When he returned after three weeks to Vienna he heard to his dismay that his friend Pro' fessor Kolletschka had died. Kolletschka had been doing most of the post mortems connection with forensic medicine and, while performing a post-mortem, cut hi?
finger. An infection set in with severe lymphangitis and lymphadenitis and death occurred within a few days. The findings at the post-mortem were: bilateral pleurisy* pericarditis, peritonitis, meningitis, metastases in one eye?very much as he had seen in so many of his patients who had died of puerperal fever.
It now became clear to Semmelweis that there must be a direct connection between the death of Kolletschka and the deaths of hundreds of his patients, in fact, that he ha died of puerperal fever. The medical students coming from doing post-mortems undef supervision of the Professor or his assistants, and then coming directly to the Lying"111 Division and examining the women in labour, must be the carriers of some sort of poiso11 which was causing the puerperal fever. He came to the conclusion that particles fr0^ a corpse, were adherent to the fingers of the students or the doctors passing dire^v from post-mortem room to the women in labour and there examining patients with01-1 properly washing their hands. It was, he believed, their fingers that were responsio for the introduction of the material which carried the fever that killed his patients. To prove the correctness of this view Semmelweis, in 1847, made it a rule that solution of Calcium Chlorate before examining patients. The immediate result was a i ??
r / > ? students and doctors must wash their hands first with soap and water and then startling change in the mortality rate of the first clinic. From more than 12 per cen ' it sank, to the same level as that of the second clinic.
In October 1847, a patient in labour and suffering from a carcinoma of the uter was admitted to bed number one where the round always started. After she had t>e examined, the students and doctors washed their hands but with soap and water 0 J and of 12 women who were delivered at the same time, 11 died of puerperal fever. A was for Semmelweis proof enough, that not only disentegrating organic material fro a corpse but putrefying organic material from the living is capable of Pr0(}nCL 3 puerperal fever. Soon after there was a like experience with a woman suffering fro septic knee, and his views were reinforced. t^e Just at this time Professor Klein, who seems to have disliked Semmelweis fronj1 beginning, began to make difficulties, which in the end forced Semmelweis to e ^ Vienna. Without giving any reason he ridiculed Semmelweis before the medica dents by pointing out that Semmelweis' views were not sufficiently tested; and he g ^ orders that no further Calcium Chlorate should be supplied to the wards, as the . was too high. As a matter of fact it was very cheap, and, as Semmelweis wras determ to use it, he provided the necessary money himself. iiyeis But Klein was not beaten; he now told the students that the ideas of Semme Uere useless, and that he had no objection if the orders of Semmelweis on washing ^ere not observed. Meantime, the views of Semmelweis had been favourably mentoned in two articles by Hebra in a Viennese journal (December 1847 and April 1848) a Haller, one of the physicians also spoke of Semmelweis's success in a lecture and ^pressed himself favourably concerning the practical consequences of Semmelweis's ^octrine. The first full exposition was that of Skoda in a lecture delivered in the lennese Royal Academy in 1849.
May 1850 Semmelweis himself developed his evvs ?n the cause of puerperal fever and rejected the idea of direct contagion. Not ?Very patient suffering from puerperal fever will transmit the condition to a healthy person, and on the other hand, a healthy person can become infected with puerperal Ver ?rorn a person who herself is not suffering from the disease. As a comparison he 7s: every person suffering from small-pox is capable of transferring the illness to ealthy person, and a healthy person can only be affected with the same disease by a Pers?n suffering from smallpox. No person will become infected with smallpox from its^erS?n su^er^n? from a carcinoma of the uterus. When puerperal fever takes th C?Urse under conditions where no organic material disintegrates or putrefies, disi1 PUerPeral fever is not transferable to a healthy person. If on the other hand j |nte?ratmg organic material is produced in the course of puerperal fever, as for ance a septic endometritis, then puerperal fever is transferable to a healthy person.
sit'Gr i* is transferable from any corpse, but then it is the degree of decompoare ** W matters. Puerperal fever may originate from diseases which by themselves he n0t PuerPeral fever, for instance erysipelas, carcinoma of the uterus, etc. Therefore, a h C(]n^Ucies> puerperal fever is not a contagious disease, but it is transferable to 0ut y person by decomposing organic matter. Such a transfer can start anywhere e_i ,l e or inside the human body where continuity of the normal integument, jter^s or epithelium is broken. Kle' >0U^ ^ere be recalled that along with the high mortality rate of the mother at ers> s elinic was the perhaps still higher death rate of the new-born, who after the moth-Were ^ths were transferred to a foundling asylum. There too the post-mortem findings Port l .ntical with those of their mothers: Bednar, the physician to the asylum rewe k ln I^50: "septicaemia in the newborn has now become very rare and for that vent.-Ve to thank the discovery of Semmelweis who found the cause and means of pre-stiU 1^.?^ ^is murderous disease". Most Continental obstetricians and pathologists fever eved that a genius epidetnicus, i.e. a cosmic or telluric miasma caused puerperal exr>r anc^ the doctrine of Semmelweis was rejected by most. Their view was rigorously lun 6jSed in 1858 by the Academy of Medicine in Paris and in 1861 by the "Versamm-Parjs eutscher Naturforscher" (Congress of German Scientists) at Speyer. Dubois in Se-^ the highest medical authorities in France said in 1858: "The views of pUern elxyeis generally accepted in Germany and England, that the transmission of or by H feyer may take place by the blood, by various discharges from the diseased is by n ecornP?sing organic material, has been proved wrong, and perhaps this doctrine n?t m ?w c?nipletely forgotten at the place where it originated. But of course that does not th'4? *^at ?ne should not be careful and take all precautionary measures but I do vig0 that all the contagious qualities are either so constant or so persistent or ^pitaf ^ WaS a^e?ed in the reports. If it were really so serious, the whole staff of the stantiv k W.0u^ have to be kept in strict quarantine, otherwise the public would con-assu^ .e ln ?reat peril. Therefore it is due to the public to reduce the exaggerated c?nditi 10ns t? their proper level. In many women before delivery these are Private nS favour the development of puerperal fever, as can often be seen in arrive if'Ct\ce and in hospitals. In the latter many women, pregnant or in labour, ^erHrtiel .ev^ent symptoms of puerperal fever which very often takes a rapid course." AnotheClS answered "My teaching is slandered in Vienna but not forgotten." a speCui r ?Pponent was the pathologist Virchow in Berlin who called Semmelweis ator and in 1858 still made the weather responsible for puerperal fever.
Semmelweis called him a bad pathologist. In 1863 Virchow was still saying "The main factor in the origin and the spread of puerperal fever is a predisposition of the individuum for the development of diffuse and malignant types of inflammation and therefore the development of puerperal fever can happen even without a contagium' ? And again "For many years while I have daily handled corpses and pathological specimens I have been at the same time, in my wards at the Charite, and have treated women in child-bed with the very best results".
The most violent opponents of Semmelweis were, however, his fellow gynaecologists. It would take several articles to quote all the opponents who made life for Semmelweis hard indeed. One of the most emphatic was Scanzoni, Professor 01 Obstetrics in Wurzburg, and previously in Prague and there developed a quarrel between the two which went on for years; Semmelweis called him "the Nero 01 Medicine".
Semmelweis continued to try very hard to convince his chief Klein, that the measures taken by him were effective and that other obstetricians in Vienna and Prague as weN as in Germany, France and England were sending him favourable reports. The relationship between the two grew worse and in 1849 Semmelweis decided to resign his post and to ask for right of a free teacher at the University, which he hoped would be granted him with the help of his friends Skoda, Rokitansky and Hebra. But he reckoned without Klein, whose influence with the authorities was so strong that the request of Semmelweis was bluntly rejected without reason given. A year later he made a second application and this time it was granted but with the restriction that he was allowed to discuss only the theory of obstetrics and that no practical demonstration was allowed.
Tired and disappointed he left Vienna for Budapest in 1850. Soon after he met hlS colleagues at a discussion of the Budapest Medical Society and his theory was of cours^ discussed and straightaway attacked. He was told that there was a serious outbreak 0 puerperal fever at the St. Rochus Hospital where there are no students to be blafl\e j When he went there the next day he found that the surgeon in charge of the hospi*3 was not only looking after his surgical and gynaecological patients, but he was att*1 same time also pathologist of the place and he and his assistants did all the p? ^ mortems! In 1851, Semmelweis was appointed unpaid Honorary Primarius and chie of the gynaecological and obstetrical unit at the St. Rochus Hospital, a post he he until 1857. In 1855, a^ter death of Professor Birly, he was appointed to the cha^ and became professor ordinarius at the University. The condition of the buildings the St. Rochus?and the University Hospital in Budapest were if possible even wof than in Vienna.
The remaining years of his life were spent in Budapest, where he tried hard to c?j* vince his colleagues and pupils of his views. He proded their truth by reducing 1 death rate of puerperal fever to a hitherto unknown low figure; yet he still met ne 1 opposition and he became a tired, exhausted man, often suffering from insomnia ? talung refuge in hard work. At the end of 1864 a condition developed which for a ^ kept him from work. He recovered but, in 1865 it was found necessary to admit hiin a private asylum in Dobling near Vienna, where Hebra had found a room for ^ ^ He died a few days later of a septicaemia from a small wound on his finger, acquit an operation which he performed in one of his last lucid moments. The post-mof findings (recorded on the death certificate) were exactly the same as those ot victims of puerperal fever. He was buried in Vienna. Thirty years later his body brought to Budapest and buried there. ,0tC As we have seen, the situation on the Continent was as black as it could be "e. r Semmelweis took up his fight against the mortal danger of childbed fever. The si , tion in England and in Ireland was very different. The main reason for this firstly that puerperal fever was regarded there as a contagious disease and strict,^ejs cautions were taken to prevent its spread; and secondly, that long before Semme gutted his calls of warning the same ideas had been expressed there and led to the Ch Try Precauti?ns-These included the washing of the hands in antiseptic liquid. ?f attendants and also of any material likely to come into contact with the r ent> as bed linen, towels, sponges, instruments: proper ventilation of the labour Pat"1*1' ma*ntenance ?f an even moderate room temperature and correct posture of the p .ent* As a result of his methods he reported that of the large number of lying-in res ^ntS delivered, he had never lost one from puerperal fever. Similar good frQU ts White's methods were reported from Dublin. In 1841 Storrs of Sheffield, to th OWn observations and from evidence collected among his friends came ,e conclusion that (1) puerperal fever may be communicated by touch and (2) that and ?1^lnates in some animal poison, especially from erysipelas and its complications the a ^es.ser degree from typhoid fever. He therefore drew up the following rules for ex . stetncian: (i) to avoid treating cases of erysipelas and (2) to avoid post-mortem titin lnatlons-If either or both of these procedures are unavoidable, then the prac-a~a-er should use disinfectants and change his clothes. Thus, disinfection measures w;?iSt Puerperal fever were already used in Great Britain and Ireland before Semmelof warning. Sem ' ^rneth, an assistant in the Viennese Obstetrical Clinic for midwives, a friend of ?bstetC-? *s and one of his earliest disciples, wrote in 1847 to the most famous asked rjClan.and gynaecologist of the time, James Young Simpson in Edinburgh and d0ct ? 0r his opinion. Simpson mistook the theory of Semmelweis for the English With qG c?ntagion and was caustic in his reply. Later Simpson was made familiar dig^if-e,mrnehveis' views by Arneth in person and his reception was tolerant and fever c-while at the same time he put forward his own idea of the cause of puerperal from" lmPson thought, that generally, if not always, the material which, when carried iriocul?K? Subject to another, could produce puerperal or surgical fever in a newly pox subject, was an inflammatory secretion, like the inoculable matter of smallkinds ?jT~Pox>. syphillis etc. Obstetricians had now a very decided proof of various ing t0 rnorbid matters which were capable, when inoculated into the vagina of leadspecifi PUerperal fever. Simpson later abandoned the opinion that puerperal fever is a fever" 1 Conta?ious disease and considered it to be identical with surgical fever. "The Well as tl? S-a^S' "*s not cause the accompanying inflammation but the fever as ti?ns r c inflammations are the result of a common cause, namely the original corrupter er blood. But what causes the corruption of the blood must be answered in a Se^mei a more developed pathological anatomy, histology and chemistry", of the ^eiS answered Simpson by saying: "By Pyaemia I understand a disintegration matter h brought about by the introduction of a decomposed animal-organic fading0fStlCSyounger men, for whom antipathies are unthinkable, to whom the l*c?mprehCOarSe t^rades ab?ut "genius misunderstood" are merely tedius, often find it ensible that the logical conclusions to the doctrine infection were nowhere drawn: I refer to the local treatment. The efficient application of disinfection in toi^' wifery is without doubt due to surgery yet most certainly it should have been the reverse. If the councils of Semmelweis had been followed, the truth of his doctri^ would have been demonstrated in the compelling language of statistics, and so perhap obstetrics would have stood in the forefront of the greatest advance in medicine of3 time". j Semmelweis was not first to realize the devastations caused by puerperal fever, b11 none of his predecessors nor contemporaries had posed the problem of puerpera sepsis as clearly as he, for Semmelweis this was not only the fulfillment of his pr0, fessional duties; it was a mission. Two discoveries at the beginning of this era 0 medicine had been of the highest importance in saving of life and preventing suffering the discovery of Edward Jenner and that of Ignaz Semmelweis. In neither case did W discovery fall from heaven; in neither case was there a grasping of Promethean fr?' for neither can one speak of inspiration. The discovery of Semmelweis was possi^ only for one who had prolonged and laborious preparation, who had directly observe and had reflected without preconceptions, whose intellect was alert and keen > reason of his human sympathy. The magnitude of his service to mankind on the 0 hand and his sufferings from jealousy, ignorance and ingratitude from his conte^ poraries on the other hand were extraordinary. The methods used against him belittle and to destroy him were of a unique variety, intensity and extensivene^ When I have sometimes asked people whether they know or have heard of the name ^ Semmelweis the answer has been "Oh yes, but I cannot remember what he was did"; or not infrequently "Never heard of him"! ,e But I am sure many of you will agree that he deserves to be remembered as one of great personalities of the guild of Hippocrates.